Nevra Seyhan

Management of temporomandibular joint ankylosis with temporalis fascia flap and fat graft

AIM Temporomandibular joint (TMJ) ankylosis is a serious problem that restricts jaw mobility and causes disturbances in facial and mandibular growth. The purpose of this paper is to present an easy and versatile method for the treatment of TMJ ankylosis to decrease postoperative complications such as re-ankylosis. MATERIAL AND METHOD Eleven patients who presented with ankylosis of the TMJ underwent surgical release. After performing gap arthroplasty through a preauricular approach, the temporalis fascia flap was transposed to the gap. An autogenous fat graft was then obtained from the abdomen and used as interpositional material. The follow-up time was 3-5 years. RESULTS Re-ankylosis did not occur in any of the patients, and all had satisfactory mouth opening. CONCLUSION Surgical treatment of TMJ ankylosis with gap arthroplasty, interposition of the temporalis fascia flap and fat grafting is an effective and easily procedure for preventing of re-ankylosis. The autogenous nature and close proximity to the joint are the main advantages of the temporalis fascia flap when compared with other interpositional materials, and the fat graft provides additional support by reducing pressure.

The effect of combined use of platelet-rich plasma and adipose-derived stem cells on fat graft survival.

BackgroundFree fat grafts have an unpredictable survival rate that limits their successful use. To increase the viability of fat grafts, it is important to minimize the reabsorption rate. ObjectiveOur aim was to investigate whether the combined use of platelet-rich plasma (PRP) and adipose derived stem cells (ADSCs) would contribute an improvement in lower resorption rates of fat grafts. MethodsInbred Fischer 344 rats were randomized into 4 groups (n = 10). Fat grafts were mixed with Dulbecco modified Eagle medium in group A, with PRP in group B, with ADSC in group C, and with PRP + ADSC in group D and were injected to the scalp.In vitro growth factor (vascular endothelial growth factor, transforming growth factor-&bgr;, and fibroblast growth factor) levels were compared using enzyme-linked immunoassay method. After 12 weeks weight, volume and histology of the transplants were evaluated. ResultsThe mean weight and volume of the fat grafts were highest in group D. Histopathological investigations revealed that the number of viable adipocytes and blood vessels were highest in group D. The level of growth factors was significantly higher in stem cell plus PRP group. ConclusionAdipose-derived stem cells combined with PRP can enhance the survival of transplanted fat tissue.

Comparison of the Effect of Platelet-Rich Plasma and Simvastatin on Healing of Critical-Size Calvarial Bone Defects.

Objective:In previous studies, it has been shown that both simvastatin (chlolesterollowering drug) and platelet-rich plasma (PRP) were capable of promoting bone formation. The aim of this study was to compare the effects of PRP and simvastatin on healing of critical-size bone defects. Methods:A total of 33 rats (3 for PRP preparation) were used in the experiment. Critical-size defect 8-mm diameter was created in 30 rats’ calvarium. Rats were divided into 3 groups. Each group contained 10 animals. In Group A the defect was filled with phosphate-buffered saline only, in Group B with 0.5 mL PRP, and in Group C with 0.1 mg simvastatin. The defects were evaluated by radiographic analysis at 8th and 16th weeks. The animals were sacrificed 16 weeks after the surgery. Histological examination was performed to assess the new bone-forming area. Vessels, fibroblasts, osteoblasts, and osteoclasts were marked in 524749.1-&mgr;m2 area and counted with using Clemex Vision Lite 3.5 Image Analysis program. The results were statistically analyzed.

Lower eyelid reconstruction with tarsoconjunctival flap in a xeroderma pigmentosum patient

Xeroderma pigmentosum is an autosomal recessive genetic disorder of DNA repair in which the ability to repair damage caused by ultraviolet light is deficient. This disorder leads to multiple basal cell carcinomas and other skin malignancies at a young age. The eye is the second most commonly affected organ. We present a case of xeroderma pigmentosum with basal cell carcinoma totally infiltrating the lower eyelid. The reconstruction after excision has been planned with a tarsoconjunctival flap (modified Hughes procedure). This procedure had evolved over the years since it had been first described by Hughes. Some important modifications have led the flap to be used with much success. Our aim is to show that the tarsoconjunctival flap is a reliable option in the reconstruction of total lower eyelid defects, with good functional and esthetic outcomes.

Malignant triton tumor of the oral cavity: a rare occurrence

Malignant peripheral nerve sheath tumors (MPNST) arise from Schwann cells or within existing neurofibromas and, as a group, account for approximately 5–10% of all soft tissue sarcomas [1]. AlthoughMPNST may consist of tissues such as glandular epithelium, squamous cell, cartilage, or bones, those which possess only skeletal muscle differentiation are referred to as malignant triton tumor (MTT). The tumor consists of two cell lines, rabdomyoblasts and Schwann cells [2]. Rhabdomyosarcomatous elements were first described by Mason in patients with neurofibromatosis [3]. One third of these tumors arise in the head and neck region and at least one third are associated with neurofibromatosis type 1 [4]. The biological behavior of this tumor is more aggressive than the usual malignant schwannoma. It shows rapid growth, early metastases, and poor prognosis [5] and therefore should be regarded as a distinct clinical entity. We present a case with MTT of the oral cavity which is a rare localization for this tumor.

EXTENSOR TENDON RUPTURE DUE TO CUTANEOUS LEICHMANIASIS: A CASE REPORT

Acute cutaneous leishmaniasis is a parasitic infectious disease prevalent in tropical areas. Most doctors in non-endemic countries are not familiar with this disease. Spontaneous tendon ruptures occurring by different mechanisms have been described in the literature but a tendon rupture caused by a skin ulcer secondary to a parasitic infection has not been reported before. In this article clinical and diagnostic features of cutaneous leishmaniasis are reviewed and a case with spontaneous extensor tendon rupture due to cutaneous leishmaniasis is presented.

Saving the zone of stasis in burns with melatonin: an experimental study in rats

BACKGROUND Studies aimed at recovering the zone of stasis are one of the major issues of experimental burn studies. Many drugs including antithrombotics, anticoagulants, anti-inflammatories have been investigated experimentally for saving the zone of stasis. In this study, the effect of the systemic melatonin on the zone of stasis was evaluated. METHODS Twenty Wistar Albino rats were used in the study. Rats were assigned to two groups (n=10). The metal comb 1x2 cm in size was immersed in boiling water and held for 20 seconds on the back of the rats to create burn wounds.No treatment was given to the control group. Melatonin was given at a dose of 10 mg/kg/d by intraperitoneal injection in the treatment group for 7 days. Daily digital photographs of both groups were obtained. Total necrotic burn areas and the zone of stasis were assessed with Auto CAD and Visual Analyzing computer programs. At the end of one week, rats were sacrificed and skin biopsies were taken for histological examination. Edema, congestion, inflammatory infiltration, vascular proliferation and fibrosis were the parameters evaluated. Data were evaluated statistically by Chi-square test and Student-t test RESULTS When histopatologic data and the measured values for total necrotic areas and zone of stasis of the experimental group werecompared to control group, the results were statistically significant (p<0.05). CONCLUSION According to the results of this study, melatonin is efficient in saving the zone of stasis in burns.

Rhabdomyosarcoma in an adult hand.

Abstract Rhabdomyosarcoma (RMS) is a malign tumour which arises from cells committed to a skeletal muscle lineage. It constitutes 4%–8% of all childhood malignancies but is rare in adults. The rare pleomorphic subtype occurs almost exclusively in adults and most often involves the extremities. RMS of the hand or foot comprise a minority of extremity cases. An adult patient with rhabdomyosarcoma in the hand, which is very rare, is presented in this article. General characteristics of the tumour and the treatment strategies are discussed.

Surgical correction of ptosis in chronic progressive external opthalmoplegia

Chronic progressive external opthalmoplegia (CPEO) is a neuromyopathic disorder characterized by progressive weakness of the extraocular and levator muscles, which causes blepharoptosis. Ocular motility is impaired. It is usually bilateral and symmetrical. Lagophthalmos and ectropion are frequent because the orbicularis oculi muscle is commonly involved [1]. Other clinical findings are poor Bell’s phenomenon and poor lid closure. CPEO tends to begin in young adulthood. Mitochondrial DNA mutations are increasingly being recognized as the etiology for CPEO [2]. Meticulous clinical examination in all cases of ptosis is necessary to identify CPEO as the underlying cause. We present a case of blepharoptosis with CPEO diagnosed as mitochondrial myopathy and the clinical features and the strategies for the surgical treatment of ptosis in this rare syndrome are reviewed. Case report

An unusual cause of cold injury: liquified petroleum gas leakage.

Liquefied petroleum gas (LPG) is an odorless and colorless gas that is a mixture of hydrocarbons (propane and butane). It is now more commonly preferred among drivers as an auto-gas throughout the world because it is cheaper than petrol or diesel and produces the same amount of energy. Because of its rapid vaporization and consequent lowering of temperature, it may cause severe cold injuries. A 33-year-old male who suffered from hand burn due to LPG is presented in this article. In LPG-converted cars, if the conversion has not been done properly, LPG may leak. Thus, the public must be informed of this potential danger while undertaking repairs of their vehicles.